3001 Westward Drive, Nacogdoches, TX 75964 · Nacogdoches County · (936) 569-2631
108 certified beds, about 82 residents a day · For profit - Corporation · Medicare and Medicaid since 1991
CMS Care Compare ratings, data as of September 1, 2026 · CCN 455959 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on June 25, 2025, inspectors cited 1 health deficiency (the Texas average is 9.4, the national average 9.2).
Of 24 health citations since March 2023, 2 were rated as actual harm or immediate jeopardy to residents (2 immediate jeopardy).
CMS lists 3 fines totaling $25,036 in the last three years; the largest was $14,901, and the latest is dated June 25, 2025.
Nurses and nurse aides worked 3.27 hours per resident per day, against 3.39 across Texas and 3.86 nationally. Registered nurses accounted for 0.17 of those hours.
CMS links it to Creative Solutions in Healthcare, an affiliated group of 149 nursing homes.
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 24 health citations on file.
Inspectors wroteBased on interview and record reviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 (Kitchen 1) of 1 kitchen reviewed for food safety requirements .The facility failed to ensure temperatures of foods were checked as required for food safety on 9/1/25, 9/3/25, 9/4/25, 9/7/25 through 9/10/25, 9/13/25 through 9/24/25, 9/26/25, 9/30/25, 10/3/25 through 10/9/25, and 10/11/25 through 11/4/25. This failure could place residents at risk for food-borne illnesses and decreased quality of life.
Inspectors wroteBased on observations, interviews, and records review, the facility failed to ensure the resident environment was free of hazards for 1 of 4 residents reviewed for accidents. (Resident #81). The facility failed to ensure the safety and well-being of Resident #81 by not following procedures for exiting residents from the van using the wheelchair lift. The noncompliance was identified as PNC (past noncompliance). The IJ began on 05/28/2025 and ended on 05/28/2025. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk for potential accidents, injuries, harm, or death.
Inspectors wroteBased on observation, interview, and record review the facility failed to provide the necessary services to maintain grooming and personal care for 2 of 5 residents (Residents #1 and #2) reviewed for ADL care. 1. The facility failed when Resident #1 had long fingernails with a visible black/brown substance underneath them on 5/20/25 and had not received regular or as needed nail care. 2. The facility failed when Resident #2 had long fingernails with a visible black/brown substance underneath them and long toenails on 5/20/25 when the Resident #2 did not receive regular or as needed nail care. This failure could place residents who required assistance from staff for ADLs at risk of not receiving care and services to meet their needs which could result in feelings of poor self-esteem, lack of dignity, and health.
Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the resident environment remained as free of accident hazards and each resident received adequate supervision as is possible for 2 of 6 resident (Resident #1 and Resident #2) reviewed for accidents and hazards. 1. The facility failed to ensure Resident #1 did not wander outside of the facility and down the road while wearing a wander guard. On 1/04/2025 Resident #1 while wearing a wander guard left the facility through the front door and was seen walking down the road by another resident's family member who notified the facility of Resident #1's whereabouts. The non-compliance was identified as past non-compliance. The Immediate Jeopardy (IJ) began 01/04/2025 and ended on 01/08/2025. The facility corrected the non-compliance before surveyor's entrance. 2. [...]
Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices, as based on the comprehensive assessment of the residents; in that: 4 out of 5 residents reviewed incontinence (Resident #5, #6, #7, #8) The facility failed to ensure Residents #5, #6, #7, and #8 were not wearing two briefs after incontinent care was provided. Residents #5, #6, #7, and #8 were observed wearing two briefs at the same time. These deficient practices could place residents at-risk for infections and skin break downs due to improper care practices.
Inspectors wroteBased on interview, and record review the facility failed to ensure residents the right to be free from abuse and neglect for 1 of 6 (Resident #4) residents reviewed for abuse and neglect. The facility failed to ensure Resident #4 was free from verbal abuse from Resident #3 on 10/31/2024 during a resident to resident verbal altercation. These deficient practices could place residents at risk for abuse, neglect, and not having their needs met.
Inspectors wroteBased on interview and record review, the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, were reported immediately, but not later than 2 hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, to the administrator of the facility and to other officials (which included to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures for 2 of 6 residents (Resident #4 and Resident # 3) reviewed for abuse. The facility failed to keep Resident #4 safe from verbal abuse from Resident #3. [...]
Inspectors wroteBased on interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assures the accurate acquiring, receiving, dispensing, and administering of medications for 1 of 6 residents (Resident #3) and reviewed for pharmacy services. The facility failed to ensure Resident #3 ingested all medications as prescribed and was not able to stash medications in room. On 10/31/2024 Resident #3 had a psychotic episode, and 40 to 50 pills were found on the floor in Resident #3's room. On 1/29/2024 Resident #3 had a psychotic episode, and 10 to 15 pills were found in Resident #3's room. These failures could place residents at risk for the unsafe administration of medications, not receiving prescribed doses of ordered medications and not receiving the intended therapeutic benefit of the medications.
Inspectors wroteBased on observations, interviews, and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 4 staff (CNA A and CNA B) and 2 of 4 residents (Resident #13 and Resident #65) reviewed for infection control. CNA A did not change gloves or perform hand hygiene during incontinent care to Resident #13 on 4/22/2024. CNA A and CNA B did not change gloves or perform hand hygiene during incontinent care to Resident #65 on 4/22/2024. These failures could place residents at risk of exposure to communicable diseases and infections.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that each resident had a right to privacy during medical care for 1 of 25 residents (Residents #13) observed for privacy. The facility failed to ensure full visual privacy during incontinent care for Resident #13 on 04/22/2024. This deficient practice placed residents at risk of loss of privacy and dignity.
Inspectors wroteBased on interviews and record review, the facility failed to complete a significant change MDS assessment within 14 days after a significant change in the resident's mental and physical condition for 1 of 6 residents (Resident #4) reviewed for assessments. The facility failed to reassess Resident #4 following a hospice admission (specific care for the sick or terminally ill) on 12/15/2023. This failure could place residents at risk for not having their individual needs met due to inaccurate assessments.
Inspectors wroteBased on interviews and record review, the facility failed to refer all residents with newly evident or possible serious mental disorder, intellectual disability, or a related condition for level II resident review upon a significant change of condition for 1 of 6 Residents (Resident #32) reviewed for PASSAR (Preadmission Screening and Resident Review Services). The facility failed to ensure Resident #32 had a new level 1 PASSAR completed with a new diagnosis of Post-Traumatic Stress Disorder (a mental health condition that develops following a traumatic event characterized by intrusive thoughts about the incident, recurrent distress/anxiety, flashback, and avoidance of similar situations) and major depressive disorder (persistent feeling of sadness and loss of interest that interferes with daily life). [...]
Inspectors wroteBased on interviews and record review, the facility failed to review and revise the person-centered care plan to reflect the current condition for 1 of 6 residents (Resident #32) reviewed for care plans. The facility failed to ensure Resident #32's care plan reflected a diagnosis of PTSD (a mental health condition that develops following a traumatic event characterized by intrusive thoughts about the incident, recurrent distress/anxiety, flashback, and avoidance of similar situations). This failure could place residents at risk of not receiving appropriate care to meet their current needs.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 2 of 5 residents (Resident #65 and Resident #62) reviewed for transfers and accident hazards. The facility failed to ensure Resident #65 was transferred using a gait belt on 4/22/2024. The facility failed to ensure Resident #62 did not have his smoking materials that included a lighter and cigarettes in his possession on 4/22/2024 and 4/23/2024. These failures could place residents at risk of falls, injuries, and burns.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and offered a therapeutic diet when there was a nutritional problem and the healthcare provider orders a therapeutic diet for 1 of 4 residents (#15) reviewed for weight loss and nutrition. The facility failed to provide Resident #15 with therapeutic meals as indicated by the physician orders for double portions on 4/22/2024 and 4/23/2024. These failures could place residents at risk for unplanned weight loss, malnutrition, and failure to thrive.
Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure that residents who need respiratory care were provided such care, consistent with professional standards of practice for 1 of 9 residents (Resident #65) reviewed for oxygen usage. The facility failed to ensure Resident #65 had oxygen humidification when in use on 4/22/2024 and 4/23/2024. This deficient practice could place residents at risk of respiratory infections and irritation to nasal passages.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to be equipped to allow residents to call for staff through a communication system which relays the call directly to a centralized staff work area for 1 of 10 residents (Resident #77) reviewed for call lights. The facility failed to ensure Resident #77's emergency call button in the bathroom had a pull cord. This failure could place residents at risk of injury, pain, and hospitalization.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to follow their own established smoking policy for 1 of 8 resident (Resident #62) reviewed for smoking. The facility failed to follow their policy on smoking when Resident #62 had smoking materials that included a lighter and cigarettes in his possession. These failures could place residents at risk of injury, burns, and an unsafe smoking environment.
Inspectors wroteBased on interview and record review the facility failed to ensure each resident was informed before, or at the time of admission, and periodically during the residents stay, of services available in the facility and of changes for those services, which included changes for services not covered under Medicare/Medicaid or by the facility's per diem rate for 2 of 3 residents (Resident #11 and Resident #47) reviewed for beneficiary notice. The facility failed to ensure Resident #11 and Resident #47 was given a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) when discharged from skilled services at the facility prior to covered days being exhausted. This failure could place the residents at risk of not having knowledge of changes to services in a timely manner.
Inspectors wroteBased on interview and record review, the facility failed to assess each resident quarterly (every 3 months) using the MDS (minimum data set) form specified by the state and approved by CMS for 4 of 12 residents (Resident # 42, Resident # 47, Resident # 49, and Resident # 61) reviewed for quarterly assessments. The facility failed to ensure Residents # 42, # 47, # 49 and # 61 had a quarterly MDS assessment completed within 3 months from the previous assessment. This failure could place residents at risk of not receiving necessary care or receiving inappropriate care for their conditions.
Inspectors wroteBased on interview and record review, the facility failed to review and revise the person-centered care plan to reflect the current condition for 5 of 20 residents (Resident #42, Resident #47, Resident #49, Resident #54, and Resident # 61) reviewed for care plan revisions. The facility failed to ensure Residents #42, #47, #49, #54 and #61 care plans were reviewed quarterly. This deficient practice could affect residents by placing them at risk of not receiving appropriate interventions to meet their current needs.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good personal hygiene for 2 of 20 residents (Resident #11 and Resident #54) reviewed for ADLs, in that:. Resident #11 missed 11 scheduled baths in January 2023, 12 scheduled baths in February 2023, and 5 scheduled baths in March 2023. Resident #54 missed 12 scheduled baths in January 2023, 12 scheduled baths in February 2023, and 5 scheduled baths in March 2023. These failures could cause all residents not to receive daily personal hygiene services and cause the residents to have health, social, and emotional issues.
Inspectors wroteBased on observation, interview, and record review, the facility failed to follow established policy regarding smoking, smoking areas, and smoking safety for 2 of 8 residents reviewed for smoking (Resident #9 and #60). The facility failed to keep cigarette butts out of the trash can in the smoking area (Resident #9 was observed putting butts in the trash can) and failed to implement their smoking policy, ignition source was at beside of Resident #60). This failure could place residents who smoke at risk of physical harm and lead to an unsafe smoking environment.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 of 3 medication carts (nurse cart 400 hall) reviewed for labeling and storage. The facility failed to remove expired glucose control solution from the nurse medication cart on hall 400. This deficient practice could place residents at risk for improper glucose monitoring and could result in residents not receiving the intended therapeutic effects of their medications causing a health decline.
4 fire safety citations on file: 1 on June 25, 2025, 3 on April 24, 2024.
| Date | Penalty | Amount or length |
|---|---|---|
| June 25, 2025 | Fine | $14,901 |
| March 31, 2025 | Fine | $4,486 |
| March 31, 2025 | Fine | $5,649 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Texas | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 3.27 | 3.39 | 3.86 |
| Registered nurses | 0.17 | 0.43 | 0.69 |
| All nursing staff on weekends | 2.59 | 2.98 | 3.42 |
| Nurse aides | 1.96 | ||
| Licensed practical nurses | 1.14 | ||
| Nursing staff turnover (share who left in a year) | not reported | 55.3% | 45.8% |
| Registered nurse turnover | not reported | 54.6% | 42.9% |
| Administrators who left | 1 |
CMS expects 3.68 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.54 on weekdays and 2.59 on weekends, 27% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.0% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.35 in April to June 2025 to 3.27 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 3.27 | 0.17 | 3.54 | 2.59 | 0.0% | 0 of 90 | 82 |
| Oct to Dec 2025 | 3.39 | 0.18 | 3.66 | 2.71 | 0.0% | 0 of 92 | 81 |
| Jul to Sep 2025 | 3.49 | 0.18 | 3.76 | 2.78 | 0.0% | 0 of 92 | 83 |
| Apr to Jun 2025 | 3.35 | 0.21 | 3.63 | 2.66 | 0.0% | 0 of 91 | 82 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Texas, Jan to Mar 2026 | 3.33 | 0.40 | 3.50 | 2.93 | 2.2% | 0.7% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Staff pay reports
No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review.
| Job | Median | Middle half | Employed |
|---|---|---|---|
| Texas, all employers | |||
| CNAs (nursing assistants) | $18.03 | $16.97 to $20.71 | 88,680 |
| LPNs and LVNs | $29.92 | $27.46 to $32.89 | 57,560 |
| Registered nurses | $46.14 | $38.06 to $50.53 | 271,380 |
| United States, nursing care facilities | |||
| CNAs (nursing assistants) | $20.67 | $17.91 to $22.55 | 534,270 |
| LPNs and LVNs | $33.86 | $30.05 to $37.40 | 188,210 |
| Registered nurses | $41.11 | $37.85 to $47.68 | 142,270 |
Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Texas | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 17.3 | 15.8 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.2 | 0.3 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 2.3 | 0.8 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 4.9 | 3.3 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.0 | 1.5 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 9.3 | 14.0 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 6.8 | 3.8 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 6.3 | 9.6 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 29.3 | 25.7 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 11.0 | 12.3 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.0 | 2.2 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.8 | 2.1 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Westward Trails Nursing and Rehabilitation's Medicare short-stay residents. On returning residents home or to the community, CMS rates it no different from the national rate (45.7% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
45.7% this home
No different from the national rate
US median of homes 51.5% · Texas: 116 better, 50 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 117 eligible stays.
13.5% this home
No different from the national rate
US median of homes 10.7% · Texas: 0 better, 9 worse
Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 142 eligible stays.
8.9% this home
No different from the national rate
US median of homes 7.1% · Texas: 4 better, 11 worse
Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 88 eligible stays.
63.2% this home
Median of homes: Texas57.3% · US 56.6%
Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 57 residents counted.
0.0% this home
Median of homes: Texas0.0% · US 0.0%
Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 85 residents counted.
4.0% this home
Median of homes: Texas1.3% · US 1.7%
Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 85 residents counted.
100.0% this home
Median of homes: Texas98.5% · US 98.7%
Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 35 residents counted.
Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.
Legal business name: WESTWARD I ENTERPRISES LLC. CMS links this home to Creative Solutions in Healthcare, a group of 149 nursing homes averaging 2.1 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Huggins, Linda | W-2 managing employee | Individual | 05/01/2021 | |
| Creative Solutions in Healthcare Inc | Operational/managerial control | Organization | 05/01/2021 | |
| Blake, Gary | Operational/managerial control | Individual | 05/01/2021 | |
| Blake, Malisa | Operational/managerial control | Individual | 05/01/2021 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Chosen from this home's own inspection record.
These are the official offices in Texas. NursingHomeClear cannot take or act on complaints.